Long Beach, CA · On-site
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
Long Beach, CA · On-site
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
Long Beach, CA · On-site +1
$19.84 - $38.69/hr
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
Long Beach, CA · On-site +1
$19.84 - $38.69/hr
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
$19.84 - $38.69/hr
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
$19.84 - $38.69/hr
Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...
Description: Claims Research & Resolution Professional We're seeking dedicated individuals to join our dynamic team at VFS. Our Claims Research & Resolution Professionals are responsible for ...
Quick apply
Description: Claims Research & Resolution Professional We're seeking dedicated individuals to join our dynamic team at VFS. Our Claims Research & Resolution Professionals are responsible for ...
$16.75 - $22.50/hr
Primary Responsibilities The primary function of the Claims Research Associate position is two-fold, consisting of medical claims processing and inquiry resolution. Each claim is processed according ...
$16.75 - $22.50/hr
Primary Responsibilities The primary function of the Claims Research Associate position is two-fold, consisting of medical claims processing and inquiry resolution. Each claim is processed according ...
Birmingham, AL · On-site
$16.75 - $22.50/hr
Primary Responsibilities The primary function of the Claims Research Associate position is two-fold, consisting of medical claims processing and inquiry resolution. Each claim is processed according ...
Birmingham, AL · On-site
$16.75 - $22.50/hr
Primary Responsibilities The primary function of the Claims Research Associate position is two-fold, consisting of medical claims processing and inquiry resolution. Each claim is processed according ...
Claims Research & Resolution Professional 2 The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and ...
New
Claims Research & Resolution Professional 2 The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and ...
New
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims ...
The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims ...
The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims ...
New
The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims ...
New
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
San Antonio, TX · On-site
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...
Responsible for obtaining, researching and compiling information on claims filed for settlement. Ensures files are accurate and complete before sending to claims adjuster. Designated as point of ...
Responsible for obtaining, researching and compiling information on claims filed for settlement. Ensures files are accurate and complete before sending to claims adjuster. Designated as point of ...
$11.54 - $14.31
4% of jobs
$14.31 - $17.09
14% of jobs
$18.17 is the 25th percentile. Wages below this are outliers.
$17.09 - $19.86
19% of jobs
The median wage is $21.67 / hr.
$19.86 - $22.64
21% of jobs
$22.64 - $25.42
14% of jobs
$26.53 is the 75th percentile. Wages above this are outliers.
$25.42 - $28.19
10% of jobs
$28.19 - $30.97
4% of jobs
$30.97 - $33.74
5% of jobs
$33.74 - $36.52
3% of jobs
$36.52 - $39.29
3% of jobs
$39.29 - $42.07
3% of jobs
$11
$24
$42
| Aspect | Claims Research | Claims Adjuster |
|---|---|---|
| Required Credentials | High school diploma or equivalent; some roles may require insurance certifications | High school diploma or equivalent; insurance licensing often required |
| Work Environment | Office-based, research-focused, often involving data analysis | Field and office-based, investigating claims and interacting with clients |
| Industry Usage | Insurance companies, third-party administrators, claims research firms | Insurance companies, adjusting firms, third-party administrators |
| Common Search & Comparison | Yes | Yes |
Claims Research involves analyzing data and gathering information to support claims decisions, often working behind the scenes. Claims Adjusters evaluate and settle claims directly with policyholders, often working in the field. While both roles require insurance knowledge and certifications, Claims Research focuses on data analysis, whereas Claims Adjusters handle claim investigations and settlements.
8.0
Based on 191 frontline employees who took The Breakroom Quiz
145th of 259 rated insurance
JOB DESCRIPTION Job Summary
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
Assists with reducing rework by identifying and remediating claims processing issues.
Locates and interprets claims-related regulatory and contractual requirements.
Tailors existing reports and/or available data to meet the needs of claims projects.
Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
Works collaboratively with internal/external stakeholders to define claims requirements.
Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
Fields claims questions from the operations team.
Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
Appropriately conveys claims-related information and tailors communication based on targeted audiences.
Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
Medical claims processing experience across multiple states, markets, and claim types.
Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
Data research and analysis skills.
Organizational skills and attention to detail.
Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to work cross-collaboratively in a highly matrixed organization.
Customer service skills.
Effective verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
Health care claims analysis experience.
Project management experience.
#PJClaims
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
